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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .7-1------- - --------------------------------------------------------- �-� (Complete in Triplicate - --------------------- ------------- ---------=----- -- Date issued __- - Z .� This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local.Health District for a permit to construct and 'install the work herein described. This application is made`in compliance with County Ordinance No. 549 and existing Rules and Regulations. �, �`"' �'" --CENSUS TRACT -------------- ----------- JOB ADDRESS/LOCATIO _ ` ----- -------- ----------------------- Owner's Name _.__ - - - ------------- - ---Phone ------------------------------------ Address -------------- 17.3X----- - - ----- ----- ------------ City -- -------- --- -------------------- �Q a ----.License # � "' _ Phone ------ Contractor's Name __-----( - ---- Installation will serve: Residence Apartment House❑ Commercial❑Trailer Court `F] Motel ❑ Other -------------------------------------------- Number of living units:._-.-1------ Number of bedrooms _?'---.__Garbage Grinder ------------ Lot Size ___---______--- ---------------- Water Supply: Public System and name ____________________ --------------------------- ------Private C! Character of soil to a depth of 3 feet: Sand C] Silt❑ Clay ❑ Peat❑ Sandy Loam p5"� Clay Loam D Hardpan ❑ Adobe-❑ Fill Material ------------ If yes,type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, .etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted i�f/public sewer is available within 200 feet,) V f SEPTIC TANK [+'J Size r g r Liquid Depth ---- - ---------- PACKAGEg TREATMENT ( ] , Capacity J_2-P6__ Type --- Material_ x` No. Compartments ----_____�----..----- V- - Distance to nearest: Well ----------- 410 ---------------Foundation __Jo-_- ------.Prop. Line -10--------•- LEACHING LINE [1] No. of Lines ----------I------------ - Length of each line._--------I-V--b-- ----- Total Length --°-°------------- 'D' Box --- ------- Type Filter Material --------� A-------Depth Filter Material ---- -g--j-------------------�• � -„- � � � Propertyln Yes S No t Distance to nearest: Well ___- --sSg__- -- Foundation SEEPAGE PIT F►'� Depth �” �' Diameter ----3_�--_--- Number ----------e2-------------- Rock Filled ® �❑ -------------------- Water Table Depth ---------------- -------------•--•--------Rock Size Distance to nearest: Well ----------t-F1_!P---------------------Foundation ....LP------.---- Prop. Line _.. ..------------ REPAIR/ADb17lON(Prev. Sanitation Permit# -------- -------------------- - ------------- Date ----------------------------- Septic Tank {Specify Requirements) -------------------- - Disposal Field (Specify Requirements) -------------- ---------------------------------------------------------_.. _ .. .. y --------------------------------------------------- I ______ ______________________I ___________________ ___ (Draw exis#ing and required addition on reverse si cle) 1 hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- I sed agents signature certifies the following: - "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." ' Signed ------------------------------------------ # _ 4 _ Owner . Title -------------- --------------- (If other than owner) FOR .DEPARTMENT USE ONLY /� APPLICATION ACCEPTED BY --- --- ------------------------------------ DATE 7-_`-t- f •�d,. BUILDING PERMIT ISSUED ---------- °------------------------------------------------- -------------- ---------------------DATE --------------------------------- = ADDITIONAL.COMMENTS ---------- ------------------------------------------- - ---- -------------------------------- - ---------------------- ------ -------------------.------------ --------------------------- f -- • ------ ------- -- ai -- -------.Date ----- -- `-- / Final Inspection by: jj- I SAN JOAQUIN LOCAL HEALTH DISTRICT t i E. H. 9 1-'68 Rev. 5M t